2015 年视神经脊髓炎谱系疾病诊断标准在拉丁美洲患者队列中的应用。
Application of the 2015 diagnostic criteria for neuromyelitis optica spectrum disorders in a cohort of Latin American patients.
机构信息
Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina.
Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Venezuela.
出版信息
Mult Scler Relat Disord. 2018 Feb;20:109-114. doi: 10.1016/j.msard.2018.01.001. Epub 2018 Jan 6.
BACKGROUND
The 2015 International Panel for neuromyelitis optica (NMO) spectrum disorders (NMOSD) diagnosis (IPND) criteria was recently proposed. However, because there are no studies evaluating application of the IPND criteria in Latin American populations, we aimed to assess whether these new criteria improve the diagnostic rate and reduce the time taken to make the diagnosis in a cohort of Latin American patients.
METHODS
We reviewed medical records and applied both the 2006 and 2015 diagnostic criteria to all patients seen in four centers in Argentina, Brazil and Venezuela. Patients with multiple sclerosis (MS, n = 915) or other well-established central nervous system (CNS) inflammatory diseases were excluded. AQP4-ab status was measured using indirect immunofluorescence (23%) and cell-based assay (CBA, 77%). In addition, data on gender, ethnicity, age and symptoms at onset, relapses, neuroimaging and immunosuppressive therapy were collected.
RESULTS
A total of 104 patients were classified as presenting NMOSD (2015 IPND). Of these, 64 patients (61.5%) fulfilled the 2006 NMO criteria (32 AQP4-ab positive, 17 AQP4-ab negative and 15 unknown). Thus, 40 new patients (38.5%) were classified as presenting NMOSD using the 2015 IPND criteria (33 AQP4-ab positive, 5 AQP4-ab negative and 2 unknown AQP4-ab status), with a median time taken to fulfill the 2015 NMOSD criteria (n = 104) of 1 month (95% CI: 0.6-1.3) and a median time taken to fulfill the 2006 NMO criteria (n = 64) of 18 months (95% CI: 9-26) (log-rank test: p < 0.0001). Females, with median age of 37 years, white ethnicity and recurrent course, predominated in all samples. Ninety-nine patients (95.1%) had at least 1 of the 3 major core clinical characteristics, of which optic neuritis (56.7%) was the most frequent symptom at disease onset.
CONCLUSION
This study showed that there was a 62.5% increase in the rate of diagnosing NMOSD through the 2015 IPND criteria, in comparison with the 2006 NMO criteria, with a shorter median time to diagnosis.
背景
2015 年国际视神经脊髓炎谱系疾病（NMOSD）诊断标准（IPND）最近被提出。然而，由于没有研究评估这些新的标准在拉丁美洲人群中的应用，我们旨在评估这些新的标准是否可以提高诊断率，并缩短拉丁美洲患者的诊断时间。
方法
我们回顾了医疗记录，并将 2006 年和 2015 年的诊断标准应用于阿根廷、巴西和委内瑞拉的四个中心的所有患者。排除多发性硬化症（MS，n=915）或其他已确立的中枢神经系统（CNS）炎症性疾病患者。AQP4-ab 状态使用间接免疫荧光法（23%）和基于细胞的测定法（CBA，77%）进行测量。此外，还收集了性别、种族、年龄和发病时、复发时、神经影像学和免疫抑制治疗的症状等数据。
结果
共有 104 名患者被归类为 NMOSD （2015 年 IPND）。其中，64 名患者（61.5%）符合 2006 年 NMOSD 标准（32 名 AQP4-ab 阳性，17 名 AQP4-ab 阴性，15 名 AQP4-ab 状态未知）。因此，40 名新患者（38.5%）被归类为 2015 年 IPND 标准下的 NMOSD（33 名 AQP4-ab 阳性，5 名 AQP4-ab 阴性，2 名 AQP4-ab 状态未知），满足 2015 年 NMOSD 标准的中位时间为 1 个月（95%CI：0.6-1.3），满足 2006 年 NMOSD 标准的中位时间为 18 个月（95%CI：9-26）（对数秩检验：p<0.0001）。女性，中位年龄 37 岁，白人种族和复发性病程，在所有样本中占主导地位。99 名患者（95.1%）至少有 1 项 3 项主要核心临床特征，其中视神经炎（56.7%）是发病时最常见的症状。
结论
与 2006 年 NMOSD 标准相比，2015 年 IPND 标准诊断 NMOSD 的比例增加了 62.5%，中位诊断时间更短。
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